03998 (CSCS)r ' «r
Buildin
Addrress.. 789411 Hi(Jh
Owner
• Rose Fisher
Mailing
Address P. 0. BOX 6
City , Zip
Contractor
mer/Builder
iTas•� w
P.O. BOX 1504
78-105 CALLE ESTADO
�• LA QUINTA, CALIFORNIA 92253. ,
BUILDING: TYPE CONST. OCC. GRP.
A.P.,Number .613"770-01
Tel.
08 -1 Legal Description
Project Description ~Yotrartahop
F -"g NA, , - � �
Address
it
City �-1 1 lZip Tel.
State Lic. City
& Classif.. Lic. #
Arch., Engr.,
Designer
Address Tel.
City( Zip ( State
Lic. If
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 OO) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
r I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit, to rile a signed statement that he is licensed pursuant to
the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ I, as owner Of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions. Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If. however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusivelycontracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this: reason
Date -Ownerr ✓. ��+. _..•
r
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. .Company
❑ Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I.certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
subject to the Workers'. Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
Front Setback from Center Line—
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
whic
1 hereby affirm that there is a construction lending agency for the performance of the
work for h this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's Name
Lenders Address FINAL DATE INSPECTOR -
This is a building permit when properly filled out, signed and validated, and Is subject to ,
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct. Issued by: Date Permit
I agree to comply with all city and county ordinances and state laws relating to building
construction; and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes. 4 Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
Sq. Ft.
Size
No.
Stories
No. Dw.
. Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition O
Estimated Valuation
$8,000
PERMIT
AMOUNT
Plan Chk. Dep.
_
Plan Chk. Bal.
s42
Const.
`r- 15
Z
Mech.
Jb6! . VV
K
Electrical
( • tt w
Plumbing
r o
S.M.I.
• GO
Grading
Driveway Enc.
Infrastructure
TOTAL
f 17 E,.
-�
REMARKS
rkfi:+-ygtj';O) 1`T+ #"3l h, -V1 -04t f[%.!m
4. 4
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line—
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
whic
1 hereby affirm that there is a construction lending agency for the performance of the
work for h this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's Name
Lenders Address FINAL DATE INSPECTOR -
This is a building permit when properly filled out, signed and validated, and Is subject to ,
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct. Issued by: Date Permit
I agree to comply with all city and county ordinances and state laws relating to building
construction; and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes. 4 Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO F1 W S
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB
YARD SPKLR SYSTEM
2ND Fl SO FT. gi
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FTa
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. fpr
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CARP. SO FT. fp
GROUT
WALL SO FT. Qd
'
DRINKING FOUNTAIN
FINAL INSP.
URINAL
SO. FT. rd
ESTIMATED CONSTRUCTION VALUATION $
= S
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
I WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATIONG//1�/v
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
LATHING
SO. FT. c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID 1+/. c
SEWAGE DISPOSAL
SO.FT.GAR 3/c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO Fi7
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
GROUND PLUM
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus xS
= S
LUMBER GR.
FINAL INSP.
FRAMING /
-:7ROOFING (
FINAL INSP.
REMARKS:
VENTILATIONG//1�/v
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
''+: ,. '
COUNTY'OF RIVERS IDEr-liR �RTMENT.OF`HEALTH-ENVY RONMENTAL HEALTH SERVICES DIVISION
''`,APPLICATION FOR REVIEW OF FOOD'ESTASLISHMENT CONSTRUCTION/REMODEL PLANS
4OTE: ,"'PrAA WILL NOT BE ACCEPTED UNLESS,`
1. This Application is complete 2. Plan CheckFee is aid
0 e1 3�
'STAB,ISHMENT .. '
�ATiE
CACTUS F OVIFR - YOI I(;I iRT Cdli424P1DATE Ap, ` 2- S, 0d
'OB SITE FEE
Tn aI r�
.)DRESS- 78-411 HIGHWAY .111,LA QUINTA,CA.92253.'
ontact Person ROSE FISHER Phone325-1120
wner/Operator Name ROSE FISHER Phone325-1120
ddressP•O.BOX 57 78-030 CALLE CADIZ CityLA OUINTA,CA Zip 922.9.3
ontractor/Architect ROSE FISHER•-. Phone325-1120
ddressP-0. BOX 57 78-030 CALLS CADIZCity LA QUINTA,CA Zip 92253
GENERAL
ype of construction V_"N e Remodel of Existing .Permitted Food establishment
otal square footage (including all seating areas) 7rn Hours of Operation 10-10
eating capacity for dining: 20 Number of workers per shift (incl. mgmt.) 2
SERVICE (Indicate all methods of food services to public):
x On-site preparation (cutting, )0dWj,'g, assembly, etc.) X_Soup or Salad Bar
x Items individually'packaged by manufacturer- Customer Self-service Dispensers
Full -Service Bar
'ype of customer utensils (cups, plates, forks, etc.) X Single Service (disposable)
Multi -Use (re -usable)
'UTILITIES
ater Service: X Public Water System (*) NAME OF WATER COMPANY:COACHELLA VALLEY WATER DIST.
Private Well (Must be potable)
ewage Disposal:;(- Public .Sewer System (*) NAME OF SEWER COMPANY:COACHELLA VALLEY WATER GIST.
Septic System (must be Environmental Health Land Use approved).
-Septic, Tank Capacity:
ALL NEW CONSTRUCTION REQUIRES a letter from provider.stating establishment is or will
be connected to utility BEFORE PLANS SHALL BE'APPROVED. This utility connection is the
responsibility of the applicant/operator and .will be verified prior to approval to
operate facility.
cease Interceptor: Connected to public sewer:' NOTE: REQUIRES interceptor size
'requirement or waiver letter from sewerage provider.
Connected to septic system Capacity of grease interceptor:
WNER/REPR SENTATIVE DECLARATION:, I,understand that the amount of fee paid is,base,d on my
eclarati!on of information on this form, and that incorrect information is grounds for denial
f the submitted plans. '•I also understand that plari's will be discarded if not picked up within
sixty (60)�days,of approval or denial, and that no inspection of my establishment will be
onducted,..or.approval granted to operate, until all proper information requested has been
er.ceived a d 'plans a proved and returned.
3/30/88
TGNAT yR_E 'y DATE,
OtI,-SAN, 002 (Rev. 8/87) ! �'�
L SERVICE COMPANY
A subsidiary of Downey Savings and Loan Association.
April 15, 1988
To Whom It May Concern:
Please be advised that the restrooms located on the second floor at the
Plaza La Quinta Shopping Center are public restrooms for use of customers
or visiting patrons of Tenants in the Shopping Center.
Dee Scheppler
Director of Prope try Management
on behalf or One -Eleven Investment Company
DS:db °
r I)SL Service Company ,
�� 21791 Lake Forest Drive • Suite 200 0 P.O. Box 5004 • El lbro, California 926311=1574 • 7141859-0050
of
t'/J-C,rfr,.-
mg
Tit� of 14a Wuinta
111tt-lbing anb s�'Sdfet� �inr�siun
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building
Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City regulating building construction or use. For the following:
BUILDING ADDRESS 78-411 Hwy 111
Use Classification Restaurant Bldg. Permit No. 3998
Group B2 Type Construction VN Fire Zone Use Zone CPS
Owner of Building Rose Fisher Address P.O. Box 57
City La Quinta, CA 92253
By; Tom Hartung
Date October 4, 1988
/
Building Official
r0lT IN A OON!?ICUOU! PLACE